MY APPROACH
My goal is to get you back to your best as soon as achievable. I will establish an integrated approach to your treatment and ensure that I participate in a 360-degree view of your care with my colleagues or as your treating clinicians prefer. There will be periodic follow-ups via email or phone. The approach is a collaboration with you in which a plan is devised and followed together. In my experience, this produces the best results.
RESCUE
This is the acute phase which aims at alleviating distressing symptoms as fast as possible while spending time on diagnostics that are absolutely necessary. This "takes the heat out of the moment" and enables more detailed diagnosis and treatment planning. It usually requires medication which I will titrate over the immediate next days to make sure the patient is managing and progressing.
REVIEW
Once the acute symptoms are under control and diagnostic tests have begun, this phase will bring all the results of past and additional tests required to get a comprehensive clinical assessment of my patient. Underlying causes can now be understood and further treatment planned accordingly and more precisely.
RESTORE
Here we enter the longer term plan where treatment shifts from short-term control of symptoms to addressing the underlying causes. Where an underlying cause cannot be resolved, a long-term treatment strategy aims at improving a person’s resilience, function and performance. This often requires a multi-disciplinary approach with clinicians from other medical fields, where I would coordinate the combined team.
EXAMPLE
Mrs. G has had problems with sleep for several years but usually coped by herself with some over-the-counter sleep aids. Over the last couple of months, insomnia has gotten out of control and Mrs. G feels she has not slept more than 1-2 hours per night for several weeks. She can barely function during the days and has had to take time off work. She dreads bed-time and feel anxious all day, getting into a panic when she goes to bed. She has already tried her usual remedies without any success and is feeling utterly desperate. RESCUE: after a 50 minutes consultation with taking a detailed history and focused physical examination, Mrs. G is prescribed some medications that alleviate her anxiety and gets her to sleep, together with some adjustments to her bed-times and sleep habits. Over the next 2 weeks, she has frequent, brief remote check-ins with Dr Bernath to make sure that her anxiety and insomnia improve rapidly. On some days, medications need to be adjusted. REVIEW: After a few days, sleep starts stabilising and anxiety calms down. Mrs. G has obtained copies of recent scans and blood tests and sent for Dr Bernath’s review. He orders a few more blood tests and a sleep study that gets done at Mrs. G's home. With all results together, Dr Bernath discusses with Mrs. G that in addition to further treatment for insomnia, she also suffers from General Anxiety Disorder, for which she will require treatment from a psychiatrist. RESTORE: A 12-weeks treatment plan is agreed that comprises psychological therapy sessions, a tailored set of Cognitive Behavioural Therapy for Insomnia interventions, and a course of neurofeedback. Over these 12 weeks, Mrs. G has regular check-ins with Dr Bernath and her sleeping medication is gradually withdrawn. At the end of the 12 weeks, her sleep-wake rhythm is stable, she knows how to deal with nights when she may not sleep as well. Her anxiety is much reduced and she has learnt methods to recognise upcoming anxiety and can counteract. She remains on an anti-anxiety medication for now. She will have quarterly follow-ups over the next year.